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Since December 2019, digital health applications (DiGA) have been included in standard care in Germany and are therefore reimbursed by the statutory health insurance funds to support patients in the treatment of diseases or impairments. There are 48 registered DiGA listed in the directory of the Federal Institute of Drugs and Medical Devices (BfArM), mainly in the areas of mental health; hormones and metabolism; and muscles, bones, and joints. In this article, the "Digital Health" specialist group of the German Informatics Society describes the current developments around DiGA as well as the current sentiment on topics such as user-centricity, patient and practitioner acceptance, and innovation potential. In summary, over the past three years, DiGA have experienced a positive development, characterized by a gradually increasing availability of various DiGA and coverage areas as well as prescription numbers. Nevertheless, significant regulatory adjustments are still required in some areas to establish DiGA as a well-established instrument in long-term routine healthcare. Key challenges include user-centeredness and the sustainable use of the applications., (© 2023. The Author(s).)

Background: Earlier mortality in socioeconomically disadvantaged population groups represents an extreme manifestation of health inequity. This study examines the extent, time trends, and mitigation potentials of area-level socioeconomic inequalities in premature mortality in Germany., Methods: Nationwide data from official cause-of-death statistics were linked at the district level with official population data and the German Index of Socioeconomic Deprivation (GISD). Age-standardized mortality rates before the age of 75 were calculated stratified by sex and deprivation quintile. A what-if analysis with counterfactual scenarios was applied to calculate how much lower premature mortality would be overall if socioeconomic mortality inequalities were reduced., Results: Men and women in the highest deprivation quintile had a 43% and 33% higher risk of premature death, respectively, than those in the lowest deprivation quintile of the same age. Higher mortality rates with increasing deprivation were found for cardiovascular and cancer mortality, but also for other causes of death. Socioeconomic mortality inequalities had started to increase before the COVID-19 pandemic and further exacerbated in the first years of the pandemic. If all regions had the same mortality rate as those in the lowest deprivation quintile, premature mortality would be 13% lower overall., Discussion: The widening gap in premature mortality between deprived and affluent regions emphasizes that creating equivalent living conditions across Germany is also an important field of action for reducing health inequity., (© 2024. The Author(s).)

The extent of loneliness differs internationally. Especially in the developed welfare states of Northern Europe, loneliness levels in the population are comparatively low. However, the increase in loneliness in many countries shows that existing concepts are not sufficient to provide effective protection against loneliness. Younger people also need to be strengthened so that they do not withdraw when they experience social exclusion and loneliness. This requires qualified specialists in kindergartens, schools, sports clubs, and other leisure facilities who help children and young people to establish social contacts. Friendship and neighborhood models have proven to be successful when it comes to strategies to combat loneliness. Greater identification with the neighborhood and a feeling of security help build social networks and reduce loneliness. For older people it is important to be able to stay in their usual social environment and maintain their social contacts. To this end, accessible public spaces must be combined with home care and support services that are tailored to the needs and wishes of older people., (© 2024. The Author(s).)

Background: Loneliness represents a significant health risk and is associated with numerous mental and physical conditions. The aim of this paper was to describe the prevalence of loneliness in Bavaria before and during the COVID-19 pandemic with respect to socio-demographic attributes., Methods: Data sources were the German Ageing Survey (DEAS) and the Socio-Economic Panel (SOEP). Univariate statistical analyses were carried out for different socio-demographic attributes, such as age, gender, type of household, education, and financial resources., Results: According to the SOEP, the proportion of adults who are often or very often lonely increased from 2.3% in 2017 to 16.2% in 2021. In 2021, women had a higher prevalence of loneliness than men (21.0% vs. 11.3%), and younger adults had the highest prevalence of loneliness (18 to 25 years: 31.7%) compared to the other age groups., Discussion and Conclusions: During the COVID-19 pandemic, loneliness increased in almost every population subgroup in Bavaria. Further studies are needed to examine whether this development is temporary or represents a long-term effect even after the measures to prevent the spread of COVID-19 have been lifted., (© 2024. Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature.)

Background: Loneliness is a widespread phenomenon, and it is associated with a variety of health problems and diseases. Unemployed individuals diagnosed with a mental illness (UMIs) are at a high risk of experiencing loneliness, with serious repercussions for their health and vocational rehabilitation. With this study we wanted to better understand the associations between sociodemographic variables, mental health, and loneliness in UMIs., Methods: We analyzed the data of 526 unemployed individuals that received means-tested benefits as well as at least one psychiatric diagnosis. Data were collected between September 2020 and September 2023. We conducted two robust regressions with loneliness (University of California, Los Angeles, Loneliness Scale, UCLA) as an outcome (N = 526). In the first regression, we used social network as a predictor (Lubben Social Network Scale, LSNS-6); in the second regression we included the additional predictors personal debt (yes/no), depression (Patient Health Questionnaire, PHQ-9), anxiety (Mini-Symptom-Checklist,MSCL), and somatization (MSCL) as well as age, gender, education, and living with a partner as control variables., Results: We found a significant negative association between social network and loneliness, and a significant positive association between a high level of education, depression, anxiety, and loneliness., Conclusions: Unemployed individuals diagnosed with a mental illness in our sample exhibited high levels of depression, anxiety, somatization, and loneliness. The associations between social network, mental health, and loneliness that we found emphasize the importance of psychological screening and/or diagnostics, and they highlight areas for prevention., (© 2024. The Author(s).)

For older people, a sufficient mobility offer is an essential prerequisite for participation in social life and a better quality of life. The goal should be self-determined everyday mobility that enables a satisfying and healthy life. Mobility depends on diverse individual abilities and needs. On the other hand, social structures as well as regulatory and spatial framework conditions limit the realisation of mobility services and their transport infrastructure. These framework conditions are characterised by the perception of social roles, the availability of resources and gender-specific attributions. For example, care and caring work is predominantly the responsibility of women in the age group of 50 years plus. The availability of transport infrastructure is geared towards goals that are characterised by the needs of gainful employment and not the goals of care work. Conversely, the availability of flexible means of transport, such as cars, also decreases for women in old age for economic reasons. For this reason, mobility planning should take greater account of specific needs, such as orientation towards care objectives, counselling, and health services and place a greater focus on the local area. For elderly people, especially women, security needs are often an important factor in the decision to become mobile or to forego mobility. This includes perceived subjective safety, accessibility and protection from weather conditions such as slippery surfaces or exposure to excessive heat. If these basic principles are taken into account, more people can be guaranteed self-determined participation in social life., (© 2024. The Author(s).)

Driving is the most important and safest form of mobility for the majority of senior citizens. However, physical and mental performance gradually decline with age, which can lead to more problems, critical situations or even accidents. Vehicle technology innovations such as advanced driver assistance systems (ADAS) have the potential to increase the road safety of older people and maintain their individual mobility for as long as possible.This overview article aims to identify ADAS that have the greatest potential to reduce the number of accidents involving older drivers. For this purpose, the accident and damage occurrence as well as the driving behaviour and compensation strategies of older people are examined in more detail. Suitable ADAS should compensate for typical driver errors, reduce information deficiencies and have a high level of acceptance. For older drivers, emergency braking, parking assistance, navigation, intersection assistance and distance speed control systems as well as systems for detecting blind spots and obstacles appear to be particularly suitable.Some of the disadvantages of ADAS are the lack of market penetration, acceptance problems and interface designs that have not yet been optimally adapted to the needs of older users. For older drivers in particular, it appears to be a priority to develop coherent and integrated solutions in the sense of cooperative assistance instead of pushing ahead with high and full automation with many system limits and exceptions, which can place high demands on attention, for example if the vehicle has to be taken over in a critical situation., (© 2024. Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature.)

Background: A diagnosis of dementia places a heavy burden on those affected and their families. Often, difficult decisions must be made. Ideally, people with a new dementia diagnosis make informed decisions together with family members. Digital informational materials can be an important low-threshold resource for making informed decisions. They should provide comprehensive information about dementia, including both primary prevention (risk factors for the onset of dementia) and later treatment options. They should also cover precautionary measures that can make future decisions easier (e.g., advance directives, power of attorney). However, there is currently no comprehensive overview of the various online resources for dementia-related information., Methods: This study explores digital informational materials on dementia for different target groups in the German-speaking area using an innovative systematic search strategy. It examines how these materials are structured in terms of risk factors, treatment options, and decision support. This methodological approach is new, so it is described and discussed in detail., Results: The results show that most materials are intended for people with dementia and their families. Treatment measures are often discussed without explaining the risk factors they are meant to address. There is little focus on preventive measures that could support decision-making., Discussion: The unbalanced presentation could lead to certain measures being difficult to understand (for laypeople) or to misinterpretation of risk factors. Important implications are drawn from these findings., (© 2024. The Author(s).)

Background and Aim: Due to its strong economy and a well-developed healthcare system, Germany is well positioned to achieve above-average reductions in mortality. Nevertheless, in terms of life expectancy, Germany is increasingly falling behind Western Europe. We compare mortality trends in Germany with other Western European countries, covering the period from 1960 to 2019. The focus is on long-term trends in Germany's ranking in international mortality trends. In addition, we conduct a detailed mortality analysis by age., Methods: Our analysis is mostly based on mortality data from the Human Mortality Database (HMD). Cause-specific mortality data originate from the database of the World Health Organization (WHO). For the international comparison of mortality trends, we use conventional mortality indicators (age-standardized mortality rate, period life expectancy)., Results: Compared to other Western European countries, Germany has higher mortality in the middle and older age groups. Germany's life expectancy gap compared to Western Europe has grown during the past 20 years. In 2000, Germany was 0.73 years behind for men and 0.74 years behind for women. By 2019, these figures had risen to 1.43 and 1.34 years, respectively. This is mainly due to mortality from non-communicable diseases., Conclusion: For Germany to catch up with other Western European countries, a stronger focus on further reducing mortality at ages 50+ is crucial. This also requires further research to understand the factors behind Germany's disadvantageous position., (© 2024. The Author(s).)

In view of the demographic change, the need for intersectoral care of the aging population has already been identified. The strategies for implementation are diverse and address different approaches, each of which requires different sectors to overlap. This article provides an overview of already completed and ongoing projects for the care of geriatric patients. It becomes apparent that the development of networks as an indispensable basis for intersectoral care cannot be measured in terms of direct intervention effects and therefore makes it difficult to prove the cost-benefit. It is also evident that some research projects fail to be implemented into standard care due to financial and staff shortages.Do we need a rethinking in Germany or less innovation-related funding lines for better implementation and research of existing concepts? International role models such as Japan show that cost reduction for the care of the aging population should be considered in the long term, which requires increased financial volumes in the short term. For a sustainable implementation of cross-sectoral approaches into everyday life, research should therefore reorganize tight and/or entrenched structures, processes, and financing. By linking the countless existing projects and integrating ideas from different sectors, future demands of intersectoral geriatric care may be achieved., (© 2024. The Author(s).)

Burnout and fatigue have overlaps in their symptoms. The common denominator is exhaustion. Physical activity has been shown to be a risk-reducing factor for the development or manifestation of symptoms. There is also evidence of an effect of physical activity in the acute phase, rehabilitation, and aftercare of burnout as well as in diseases that are associated with the occurrence of fatigue and their treatments.In burnout research, physical activity is considered a risk-reducing factor and coping strategy, but there are no specific exercise recommendations with regard to symptom severity. In the area of tiredness/fatigue, the overall picture is inconsistent: there are already targeted recommendations for exercise therapy in a multimodal approach for individual clinical pictures. For example, there is high evidence for the use of appropriately dosed physical activity in cancer patients in adjuvant therapy and aftercare. Other diseases associated with the occurrence of fatigue, such as long- and post-COVID, have not yet been sufficiently researched to make clear statements about a dose-response relationship. For some diseases, there are already targeted recommendations for exercise therapy in a multimodal approach.This paper aims to provide an overview of the current state of exercise research in burnout and fatigue and thus, on the one hand, make therapy recommendations for practitioners and patients, and on the other hand, shed light on the evidence in those areas in which there are (still) no general and individualized exercise recommendations and guidelines., (© 2024. The Author(s).)

Background: Fatigue is one of the most frequent symptoms in post-COVID syndrome (PCS) patients and describes a long-term feeling of tiredness and exhaustion. Frequently, it follows an infection or is a component of depressive symptoms. But fatigue itself is also a risk to mental health like other chronic conditions. The objective of this paper was to analyse the relationship between fatigue and depression/anxiety and the differences between PCS patients and fully recovered COVID-19 cases., Methods: In a longitudinal study with three measurement points, insured members of the Statutory Accident Insurance and Prevention in the Health and Welfare Service with a SARS-CoV‑2 infection in 2020 were asked about fatigue, depression/anxiety and persisting COVID-19 symptoms. To analyse the longitudinal effects of the two variables, a cross-lagged panel model was applied., Results: In the present sample (n = 860), a proportion of 68.7% to 75.1% of people was suffering from PCS. The results showed a model fit of R 2  = 61.49% and all effects were significant, but the cross-lagged effects were not significantly different from each other. If stratified according to whether PCS symptoms were present, the cross-lagged effects weakened in both groups, while the effects of fatigue on depression and anxiety only remained in the group of those affected by PCS., Discussion: The results show a relationship in both directions between fatigue and depression/anxiety. PCS patients can benefit from psychotherapeutic treatment to tackle fatigue and prevent depression and anxiety., (© 2024. The Author(s).)

Background: Older age is a risk factor for a fatal course of SARS-CoV‑2 infection, possibly due to comorbidities whose exact role in this context, however, is not yet well understood. In this paper, the characteristics and comorbidities of persons who had died of COVID-19 in Bavaria by July 2022 are shown and compared with the characteristics of other fatalities during the pandemic., Methods: Based on data from multiple cause of death statistics, odds ratios for dying from COVID-19 (compared to dying from other nonexternal causes of death) were calculated by using logistic regression models, stratified by age, sex, and pandemic waves., Results: In Bavaria, a total of 24,479 persons (6.5% of all deaths) officially died from COVID-19 between March 2020 and July 2022. In addition to increasing age and male sex, preexisting diseases and comorbidities such as obesity, degenerative diseases of the nervous system, dementia, renal insufficiency, chronic lower respiratory diseases, and diabetes mellitus were significantly associated with COVID-19-related deaths. Dementia was mainly associated with increased COVID-19 mortality during the first and second waves, while obesity was strongly associated during the fourth wave., Discussion: The frequency of specific comorbidities in COVID-19 deaths varied over the course of the pandemic. This suggests that wave-specific results also need to be interpreted against the background of circulating virus variants, changing immunisation levels, and nonpharmaceutical interventions in place at the time., (© 2024. The Author(s).)

Background: The "International Classification of Diseases 11th Revision" (ICD-11) introduces complex post-traumatic stress disorder (CPTSD) as a separate diagnosis to account for the effects that persistent or repetitive trauma can have. In CPTSD, disorders of self-organization are added to the core symptoms of PTSD. It can be assumed that those affected are impaired in their professional lives as a result. The aim of this paper is to provide an overview of the effects of CPTSD on work-related functioning and to present possible consequences for therapeutic and rehabilitative treatment., Method: A scoping review with a literature search in the MEDLINE, APA PsycArticles, and APA PsycInfo databases was conducted in February 2024., Results: Of 2378 studies on KPTBS, five studies were included, of which only three dealt more specifically with the impact on the world of work. Those affected appear to have a poorer prognosis for maintaining their ability to work and are therefore to be regarded as a socio-medical risk group with regard to long-term maintenance of participation in working life., Discussion: The current state of research on the effects of the CPTSD symptom complex on the world of work is surprisingly limited. In comparison, the results indicate that CPTSD has a greater negative impact on the ability to function in the world of work than PTSD and other mental disorders. It is still unclear which psychopathological mechanisms mediate the connection. Only basic findings on the psychopathology of CPTSD are available. Treatment approaches that address the disorders of self-organization in addition to PTSD symptoms appear necessary., (© 2024. Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature.)

Background: The digitalization in the healthcare sector promises a secondary use of patient data in the sense of a learning healthcare system. For this, the Medical Informatics Initiative's (MII) Consent Working Group has created an ethical and legal basis with standardized consent documents. This paper describes the systematically monitored introduction of these documents at the MII sites., Methods: The monitoring of the introduction included regular online surveys, an in-depth analysis of the introduction processes at selected sites, and an assessment of the documents in use. In addition, inquiries and feedback from a large number of stakeholders were evaluated., Results: The online surveys showed that 27 of the 32 sites have gradually introduced the consent documents productively, with a current total of 173,289 consents. The analysis of the implementation procedures revealed heterogeneous organizational conditions at the sites. The requirements of various stakeholders were met by developing and providing supplementary versions of the consent documents and additional information materials., Discussion: The introduction of the MII consent documents at the university hospitals creates a uniform legal basis for the secondary use of patient data. However, the comprehensive implementation within the sites remains challenging. Therefore, minimum requirements for patient information and supplementary recommendations for best practice must be developed. The further development of the national legal framework for research will not render the participation and transparency mechanisms developed here obsolete., (© 2024. The Author(s).)

Background and Aim: Heat and heavy rain can have negative health impacts for people in Germany. Vulnerable groups in particular, such as children and the elderly, are at increased risk and require special precautions. This paper examines how employers of the municipal administration and facilitating organisations perceive the risk of heat and heavy rain for daycare centres and care facilities, and to what extent an exchange takes place between the municipal level and the facilities. In addition, specially developed information materials with recommendations for action for adapting to heat and heavy rain that are aimed at such facilities were evaluated., Methods: In the summer of 2021, we conducted a quantitative survey. A total of 333 respondents from municipal administrations, facilitating organisations and institutions participated. Descriptive analyses and ANOVAs were conducted., Results: Risk perception and adaptation knowledge concerning heat was perceived higher than concerning heavy rain. The intention to support institutions in finding measures for adaptation was also higher with regard to heat. The majority of interviewees from municipal administrations and institutions communicated with institutions through various channels on different topics including the natural hazards mentioned. The information material was evaluated positively., Discussion: This article shows that facilities are seen as very affected by heat waves. Awareness towards heavy rainfall needs to be raised. The feedback on the information material clearly shows a high need in this area., (© 2024. The Author(s).)

Background: Family reconstitution and data from online genealogies, such as FamiLinx, are two potential sources for investigating mortality dynamics for the period before official lifetables became available. In this paper, we use two of them, the family reconstitution of Imhof and the FamiLinx dataset based on geni.com, to estimate dynamics in life expectancy and discuss the sex-specific differential mortality in the German Empire., Method: Sex-specific lifetables are estimated for the territory of the German Empire from the individual data of the family reconstitution and the online genealogies. On the basis of these lifetables, we estimate the conditional life expectancy and derive the corresponding sex-specific differential mortality. Findings are compared with the official lifetable of the German Empire in 1871-1910. The contribution of each age group to the differential mortality is determined using the stepwise-replacement algorithm., Results: The family reconstitution overestimates conditional life expectancy less than FamiLinx after 1871, when official lifetables are available in the German Empire. However, both sources fail to capture the sex-specific mortality differentials of the official lifetables at the end of the nineteenth century and show a higher life expectancy for males instead of females. The bias in sex-specific mortality rates is particularly pronounced in the age groups 15 to 45., Discussion: Finally, we discuss possible explanations for the biased findings. Notability bias, the patriarchal approach to family trees, and maternal mortality are important mechanisms in the FamiLinx dataset. Censoring due to mobility serves as a potential reason for the bias in the family reconstitution., (© 2024. The Author(s).)

Introduction: Affective impairments/disorders are one explanation as to why adolescents exhibit externalizing problem behavior (rule-breaking and dissocial behavior). Impaired affect is a core feature of callous-unemotional traits (CU traits). CU traits are composed of three factors: Callousness (lack of empathy and remorse), Uncaring (indifferent attitude toward task performance and the feelings of others), and Unemotional (superficial or flattened affect). Externalizing problem behaviors mostly occur in groups during adolescence. Therefore, it is important to consider the relationship between CU traits and externalizing problem behaviors that are exhibited explicitly in collaboration with or in the presence of friends. This perspective has been lacking in research on CU traits. The present study aims to fill this research gap., Methods: Self-report data were collected between June 2021 and March 2023 from N = 169 adolescents (54% female; M = 14.95 years) using a set of questionnaires that could be completed online or as a paper-pencil version. In addition to CU traits (ICU) the set of questionnaires included assessments of rule-breaking and dissocial behavior with friends (CBCL: YSR 11-18 R)., Results: Only the subscale Callousness contributes to the explanation of externalizing problem behaviors with friends (6% variance explained)., Discussion: The results indicate that the three factors of CU-traits should be considered separately. In addition, when examining externalizing problem behavior, one should consider whether it is exhibited alone or together with or in the presence of friends. Limitations of the study, ideas for further research, and practical implications are discussed., (© 2024. The Author(s).)

Background: A child's attention deficit hyperactivity disorder (ADHD) is associated with strain for the parents. In turn, psychosocial parental strain is associated with higher probabilities for the occurrence of inattention/hyperactivity symptoms (IHS) in their children. The aim of this paper is to assess the association between parental strain, IHS, and a parent-reported ADHD diagnosis of the children., Methodology: Based on data from n = 4596 participants of the KiGGS cohort (wave 2: 2014-2017), the type and extent of parental strain was set in relation to IHS and an ADHD diagnosis of the child in cross-sectional analysis. Frequencies, means, beta coefficients, and odds ratios adjusted for sex, age, socioeconomic status, and migration background are reported., Results: In individual consideration, a greater number of parental strains were associated with IHS than with an ADHD diagnosis. In a multivariate analysis, financial worries and parenting problems/conflicts with the children were significant predictors of IHS and an ADHD diagnosis, respectively. In addition, four or more types of parental strain were associated with a higher likelihood of both IHS and an ADHD diagnosis., Discussion: Financial and child-rearing strain are relevant to parents of children with IHS and an ADHD diagnosis. Interrelationships between parental stress and a child's IHS or an ADHD diagnosis can be assumed. To relieve their burden, prevention can either aim at improving the situation of ADHD-affected families or at improving the family's handling of the child's ADHD., (© 2024. The Author(s).)

The interdisciplinary care of children and adolescents with mental disorders requires services from various German codes of social law and-within the medical care system-enclosing inpatient and outpatient services. The increasing demand, the increase in severity of disorders, and the general shortage of staff in social services put pressure on the structures of the interdisciplinary service networks resulting in long waiting periods, long distances, and regionally insufficient care. The medical field of child and adolescent psychiatry and psychotherapy (CAPP) plays the central and coordinating role within the cooperative care for children and adolescents with mental disorders. The CAPP is in clear need of reforms; however, these are markedly different from the reform needs of the German somatic medical care system and differ substantially from those of the (adult) psychiatry, psychotherapy, and psychosomatics disciplines. This discussion paper describes the reform requirements, the specifics of the CAPP structures, and suggestions to overcome sectors of service provision, enhance networking, intensify telemedicine, and develop evidence-based prevention and early recognition of child mental disorders., (© 2024. The Author(s).)

The burden of mental diseases is enormous and constantly growing worldwide. The resulting increase in demand for psychosocial help is also having a negative impact on waiting times for psychotherapy in Germany. Digital interventions for mental health, such as interventions delivered through or with the help of a website (e.g. "telehealth"), smartphone, or tablet app-based interventions and interventions that use text messages or virtual reality, can help. This article begins with an overview of the functions and range of applications of digital technologies for mental health. The evidence for individual digital forms of interventions is addressed. Overall, it is shown that digital interventions for mental health are likely to be cost-effective compared to no therapy or a non-therapeutic control group. Newer approaches such as "digital phenotyping" are explained in the article. Finally, individual papers from the "Leibniz ScienceCampus Digital Public Health" are presented, and limitations and challenges of technologies for mental health are discussed., (© 2024. The Author(s).)

The nexus between urban planning and public health acknowledges the importance of creating cities that contribute to their residents' physical, mental, and social well-being. The Healthy Cities movement underlines that community participation and intersectoral work are important to create sustainable, equitable, and healthy cities.Several theoretical and practical participatory approaches form the foundation for participation in public health and urban planning. Growing digitalization has significantly transformed how participation is conducted in various fields. Digital technologies not only play a large role in daily life, but they have opened more opportunities for individuals to interact, share, and collaborate in the planning and design of cities.This article explores how digital technologies enable participation among residents and stakeholders in order to support the health-oriented planning of cities and neighborhoods. From the selective case studies presented in the paper, it can be ascertained that digital technologies can support various forms of participation by enabling different levels of engagement as well as both one-way and two-way interactions. Some forms of engagement can be supported entirely within digital platforms. However, in the case of higher engagement, which requires deeper insights into the problems and the codevelopment of solutions, other nondigital formats and traditional methods such as follow-up workshops and focus group discussions are necessary to complement the digital form of participation., (© 2024. The Author(s).)

Real-world data is increasingly becoming the focus of healthcare research in the context of digitization. The timely availability of large amounts of data gives hope that research questions can be answered quickly without additional data collection and that a direct benefit for the care of people can be achieved. Especially in acute care situations, such as heat waves or a pandemic, this can be crucial. But real-world data depend quite significantly on the quality and intent of data collection. It is also influenced by determinations on semantic and syntactic standards that are made for primary data - often considering different use cases. In the context of different initiatives on national and international levels, a holistic view on data collection and evaluation and a regular feedback mechanism between data evaluation and specifications for the collection should be established. By including requirements for secondary data evaluation in the definition processes for data collection, the informative value of the data for research can be increased in the long term.In this discussion paper, the activities for standardized data collection in the context of the digitization initiatives and the corresponding European approaches are first presented. After outlining the effects of these activities on the possibilities and difficulties of data consolidation for the analysis of real-world data, the article calls for an ongoing discourse between the different areas., (© 2024. The Author(s).)

This article addresses the question of how climate change may affect health and to what extent real-world data can contribute to research in this topic area. Climate change is altering the environmental and living conditions of humankind, and has thus also become a relevant health problem. The increase in extreme weather events, changes in exposure to UV and air pollution, and the climate-associated spread of allergens or novel pathogens are significantly changing the spectrum of diseases and the need for medical care in the population. However, in Germany, only few findings on the consequences for the healthcare system and on particularly affected population groups exist so far. Real-world data (primary data, register data, and administrative data) in combination with environmental exposure data and other relevant data (e.g., socio-economic data) have the potential to significantly advance research on the health consequences of climate change. This paper identifies changes in environmental and living conditions and associated health risks. It describes the databases that are generally available for analysing health effects of climate change. A concrete example is used to show how individual health data (in this case claims data of the statutory health insurance), environmental exposure data and other data can be successfully combined. Finally, the article offers a comprehensive overview of open research questions that can be answered with real-world data., (© 2024. The Author(s).)

The increasing digitization of the healthcare system is leading to a growing volume of health data. Leveraging this data beyond its initial collection purpose for secondary use can provide valuable insights into diagnostics, treatment processes, and the quality of care. The Health Data Lab (HDL) will provide infrastructure for this purpose. Both the protection of patient privacy and optimal analytical capabilities are of central importance in this context, and artificial intelligence (AI) provides two opportunities. First, it enables the analysis of large volumes of data with flexible models, which means that hidden correlations and patterns can be discovered. Second, synthetic - that is, artificial - data generated by AI can protect privacy.This paper describes the KI-FDZ project, which aims to investigate innovative technologies that can support the secure provision of health data for secondary research purposes. A multi-layered approach is investigated in which data-level measures can be combined in different ways with processing in secure environments. To this end, anonymization and synthetization methods, among others, are evaluated based on two concrete application examples. Moreover, it is examined how the creation of machine learning pipelines and the execution of AI algorithms can be supported in secure processing environments. Preliminary results indicate that this approach can achieve a high level of protection while maintaining data validity. The approach investigated in the project can be an important building block in the secure secondary use of health data., (© 2024. The Author(s).)

Background: Artificial intelligence (AI) is becoming increasingly important for the future development of hospitals. To unlock the large potential of AI, job profiles of hospital staff members need to be further developed in the direction of AI and digitization skills through targeted qualification measures. This affects both medical and non-medical processes along the entire value chain in hospitals. The aim of this paper is to provide an overview of the skills required to deal with smart technologies in a clinical context and to present measures for training employees., Methods: As part of the "SmartHospital.NRW" project in 2022, we conducted a literature review as well as interviews and workshops with experts. AI technologies and fields of application were identified., Results: Key findings include adapted and new task profiles, synergies and dependencies between individual task profiles, and the need for a comprehensive interdisciplinary and interprofessional exchange when using AI-based applications in hospitals., Discussion: Our article shows that hospitals need to promote digital health literacy skills for hospital staff members at an early stage and at the same time recruit technology- and AI-savvy staff. Interprofessional exchange formats and accompanying change management are essential for the use of AI in hospitals., (© 2023. The Author(s).)